Surgical Referral

The NGS does not have a surgical team, most surgeries happen overseas. The NGS does provide surgical referrals for those seeking surgery.

The first step is to speak to one of the doctors or nurses at your Endocrine Clinic Appointment. At that stage, you can talk about your plans for surgery and we can refer you for a surgical assessment. 

You must be attending our Endocrine Clinic and on hormones for a minimum of six months for mastectomy and a minimum of one year for any other surgery before we can refer you for surgical assessment. The surgical assessment takes place with the multidisciplinary team. This is similar to the initial assessment. For more information see the “What to Expect” page. 

If following surgical assessment, it is clear that surgery will help you to affirm your gender and there are no outstanding risks to your health or well-being, then we will refer you for surgery.

At present, under the public system, most surgeries are not provided in Ireland. However there are funding options available that can support you to have surgery abroad provided you are a resident (living full-time) in Ireland. We can help you to apply for that funding. Each surgery is different and details on surgical options and funding are included below. 

This information is subject to change and the most current information will be provided to you at the time of your surgical referral. 

If you have private health insurance, then please check if your policy covers gender affirming chest surgery. If your private health insurance covers top surgery, and this is something you are interested in, then we can make the appropriate referrals and help you apply for funding via your insurer. 

There is currently no public access to gender affirming top surgery in Ireland. We are working with the HSE to try to change this. If you do not have private health insurance, then we can refer you to a surgeon somewhere else in Europe and apply for funding to help cover the cost of surgery. This option via the Cross Border Directive is only available for gender affirming mastectomy.

The surgical services in Europe that we have referred to in the past for top surgery include:

  • Belgium: Prof Stan Monstrey.Ghent https://www.uzgent.be/patient/zoek-een-arts-of-dienst/genderteam
  • Germany: Dr. A. Arens-Landwehr, Dr. J. Diedrichson, Dr. T. Scholz. Dusseldorf. https://www.plastische-chirurgie-medienhafen.de/transgender-chirurgie.html
  • Netherlands: Prof Bouman in Gender Surgery. Amsterdam. https://gendersurgeryamsterdam.com
  • Latvia: Dr. Arguts Keirans. Riga. Aesthetica SIA clinic. https://aesthetica.lv
  • Lithuania: Dr Kievisas, Nordesthetics. Kaunas. http://www.nordesthetics.com
  • Poland: Mr Ludomir Lembas. Warsaw. https://www.estheticon.com/surgeons/lembas-lubomir
  • Spain: Mr Jesus Lago, Madrid. https://cirugiagenero.com/en/

Please note that none of these surgeons are employed by the HSE or have any legal or contractual relationship with us. Therefore, we cannot offer accurate information on the clinical care they offer, specific surgical options, or waiting times.

Similarly, we cannot verify the accuracy of the content of their websites.

Funding for top surgery in Europe is covered (to a certain extent) by the Cross Border Directive. You would have to pay for the surgery upfront, and then get reimbursed when the surgery is complete. The reimbursement for top surgery may not cover the total cost. 

If you have any questions about how much of the cost of surgery is covered, then you can contact the Cross Border Directive Office directly. Information on the Cross Border Directive (including contact details) can be found at https://www2.hse.ie/services/cross-border-directive/about-the-cross-border-directive.html 

If we are referring you for surgery abroad then we can help you with this funding process.

Please note that we have been advised by the Cross Border Directive Office, that they can no longer consider applications for funding to the UK. In addition, the Cross border directive have informed us that they are no longer funding breast augmentation/mammoplasty. 

There are no surgeons that can offer genital surgery in Ireland in either the public or private sector. The services in Europe that we have referred to in the past with respect to bottom surgery for men or transmasculine people include:

Please note that none of these surgeons are employed by the HSE or have any legal or contractual relationship with us. Therefore, we cannot offer accurate information on the clinical care they offer, specific surgical options, or waiting times.

Similarly, we cannot verify the accuracy of the content of their websites.

The services in Europe that we have referred to in the past with respect to bottom surgery for women or transfeminine people include:

Please note that none of these surgeons are employed by the HSE or have any legal or contractual relationship with us. Therefore, we cannot offer accurate information on the clinical care they offer, specific surgical options, or waiting times.

Similarly, we cannot verify the accuracy of the content of their websites.

Genital surgery is funded by the Treatment Abroad Scheme. Information on the Treatment Abroad Scheme can be found at https://www2.hse.ie/services/treatment-abroad-scheme/treatment-abroad-scheme.html 

This scheme will fund bottom surgery anywhere in the EU, UK or EEA as long as it is in a public sector hospital. Therefore, if you find a centre that you would like to be referred to that is not on the list above, but which meets these criteria, then let us know and we can refer you. 

Gender affirming hysterectomy is offered in the public system in Ireland. Following referral, the surgical team can discuss fertility preservation options with you when they see you. These options include egg freezing and ovary preservation. There are private options too and a HCP can discuss this with you if you have appropriate insurance. 

Gender affirming orchidectomy is offered in the public system in Ireland. There are private options too and a HCP can discuss this with you if you have appropriate insurance.  Prior to referral, we can discuss fertility preservation options with you, including sperm storage. 

Gender affirming facial surgery is not offered in the public or private system in Ireland. Neither Cross Border Directive nor Treatment Abroad Scheme funding is available for these procedures. In our experience health insurers do not cover these surgeries. However, we can refer you for facial surgery if you have the means to pursue this, and if it is part of your planned surgical transition. 

There may be a public service offering for chricothyroplasty (tracheal shave) and vocal feminisation surgery as pathways are in discussion, so if these surgeries are of interest to you, please discuss this at your next endocrine appointment or email [email protected]

As with all gender affirming surgery, we recommend multi-disciplinary assessment prior to gender affirming facial and neck surgery. 

In the first instance it is recommended that you contact your surgical team directly for advice.

If you cannot get through to your surgical team then please contact your GP or contact us at 01 211 5045 for advice.

Please note that we are not an acute or emergency service. In the case of emergency or sudden onset of serious symptoms please contact emergency services at 112 or 999.

When recovering from surgery it can be normal to feel very tired or for mood to feel low. This will usually improve with time as your body recovers. However, if you do not start feeling better, or if you would like to talk about how you are feeling, then please contact us at 01 211 5045 or by email at [email protected] 

Please note that we are not an acute or emergency service. In the case of sudden onset of serious symptoms please contact your GP or emergency services at 112 or 999.

It is likely that you will have to spend some recovery time in the country where you have your procedure. This varies depending on the type of surgery you have had and your surgical team’s recommendations. 

Please contact your planned surgical provider for information for what to expect in terms of recovery time.

Once referred for surgery, the surgical team will meet with you and give you detailed information and answer your questions. 

Some more information on surgical options and what surgery can entail, have a look at resources created by the Gender Identity Resource & Education Society (note that this is a UK site, but some of the more general information is still applicable)  :

https://www.gires.org.uk/medical-treatment-options-for-gender-variant-adults/